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Watching movie stars light up on screen is the biggest single factor in influencing teenagers to smoke, suggests a new US study.

Adolescents who had never smoked were almost three times more likely to then take up the habit if they had watched films packed with smoking scenes, compared to their peers who had seen films with the least amount of on-screen smoking.

"There was a tremendous impact," says research leader Madeline Dalton, at Dartmouth Medical School in Hanover, New Hampshire. "Movies were the strongest predictor of who would go on to smoke - stronger than peers smoking, family smoking, or the personality of the child."

"We know from past studies it's very rare for smoking to be portrayed in a negative light. Smokers [in movies] tend to be tough guys or sexy, rebellious women - which appeal to adolescents," she told New Scientist.

Dalton's colleague Michael Beach adds: "Our data indicate that 52 per cent of smoking initiation among adolescents in this study can be attributed to movie smoking exposure."

"The effect is stronger than the effect of traditional cigarette advertising and promotion, which accounts for 'only' 34 per cent of new experimentation," notes Stanton Glantz, at the Center for Tobacco Control Research and Education, in an editorial accompanying the study published online in The Lancet.

Smoke screen
The study began by recruiting over 2600 US schoolchildren aged 10 to 14 who had never smoked. Each child was then asked if they had watched any of 50 movies randomly selected from 601 box office hits released between 1988 and 1999. The number of occurrences of smoking in each film was recorded by trained coders.

When followed up one to two years later, 10 per cent of the children had tried smoking. Those in the top quarter of exposure to movie smoking were 2.7 times more likely to have tried a cigarette than those in the lowest quarter of exposure. This effect was independent of other factors that might influence the child's smoking behaviour, such as friends or family smoking.

"It's more evidence that movies have a strong impact on adolescents," says Dalton. "Previous studies have suggested that smoking in movies influences adolescent smoking behaviour, but this is the first study to show that viewing smoking in movies predicts who will start smoking in the future."

Dalton, an expert in cancer risk behaviour in children, says a previous study by the team showed that children were more likely to smoke if their favourite actor smoked.

Movies which depict smoking should be given an adult rating or "R rating" in the US, suggests Glantz, which would mean that children under 17 could not see the film without a parent. "An R rating for smoking in movies would prevent about 330 adolescents [in the US] from starting to smoke and ultimately extend 170 lives every day," he writes.